Dental Account Executive

Amerihealth Caritas•Scranton, PA

6d•Remote

About The Position

The Dental Account Executive will support Federally Qualified Health Centers (FQHCs) and multiple counties in Pennsylvania. This role is responsible for building, nurturing, and maintaining positive working relationships between the Plans and its contracted or subcontracted fully delegated vendor providers for all dental-connected products, including Medicaid and Medicare, for the benefit of the membership. The Dental Account Executive is also the point person responsible for working with providers, delegated providers, vendors, and members to increase the membership’s covered utilization of the plans. The dental account executive makes visits in person and virtually, facilitates local outreach sessions, functions as a proactive plan account leader for providers, and coordinates the resolution of member and provider issues with internal partners and the vendor.

Requirements

Bachelor’s Degree or equivalent combination of education and work experience.
Minimum of 3 years in the managed care/health insurance industry preferred
Minimum of 1 year Medicaid experience preferred.
Minimum of 1 year in an administrative Dental Provider Services position.
Previous experience working with dental/healthcare providers.
Previous dental provider relations experience preferred.
Valid driver’s license and current auto insurance.
Proficiency with MS Excel to include pivot table, Vlookup function, match function.
Data analytics, eye for detail.
Strong written and verbal communication skills.
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.

Responsibilities

Functions as a liaison between Plans and the participating AHC providers by responding to their needs and inquiries, educating providers and their office staff, and/or suggesting such activities by vendors when dealing with a fully delegated network.
Functions as an account leader for assigned providers and manages the dental office's needs in an AHC network and through the vendor in a delegated market.
Work directly with the vendor to ensure provider data accuracy and apply appropriate claims processing guidelines.
Collaborates to resolve system issues and understand and utilize the vendor's systems and reporting capabilities.
Advocate for members to access covered care by plan at AHC providers or through fully delegated network providers.
Serves as a backup to the Dental Program Manager as needed for Plan representation.
Works closely with the Medical Account Executive to manage the FQHC dental sites in AHC territories.
Supports the Quality Management Department with the credentialing and re-credentialing process and the investigation of member complaints.
Works with all departments to develop and execute strategies for optimally managing medical costs.
Assist with achieving quality and health plan objectives through accomplishing provider initiatives.
Maintains knowledge of Plan policies and procedures related to provider contracting, credentialing, provider billing and payment, physician and hospital incentive programs, Plan provider file database requirements, and other key State and Federal regulatory requirements relating to providers.
Maintains proficiency in the Plan claim adjudication system.